A 62-year-old woman develops symptomatic vault prolapse two years after total abdominal hysterectomy. She undergoes sacrospinous ligament fixation. The vault is anchored to which structure on the ligament?

• A Just lateral to the sacrum at S3
• B At its midpoint overlying the pudendal nerve
• C Just medial to the ischial spine ✓
• D At the attachment of the coccygeus muscle to the ilium

Explanation

In unilateral sacrospinous ligament fixation, usually right sided, the vaginal vault sutures are placed through the sacrospinous ligament just medial to the ischial spine. This restores apical support while avoiding the pudendal vessels and nerve that cross the posterior surface of the ligament. Placement too medially risks rectal injury and bleeding from the hypogastric venous plexus, so the landmark of the ischial spine guides safe suture placement.

Reference: Te Linde's Operative Gynecology, 12th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.